‘Will Politics Trump Facts?’ Asked as Time Runs Out on Paramedic Firefighter Quest

By Patric Hedlund

"If it isn’t fast, it isn’t emergency response…We get no rewards for same day service," said a DVD report distributed to members of the Kern County Board of Supervisors by Pine Mountain resident Scott Robinson last week. The video explains why "90 percent of North Americans" now rely on fire service-based emergency medical services. "We have a standing army prepared to respond quickly," Dr. Eugene Nagel, of the Miami Fire Department, credited as a pioneer in EMS services, says. Robinson went to see Michael Rubio, chairman of the Kern County Board of Supervisors with a handful of the DVDs to give to supervisors and their staffs last week.

Grains of sand in the hourglass appear to be running out on the struggle to initiate a county program to support firefighter paramedics in rural areas of Kern County.

Of the top 15 fire departments in the state of California, Kern County’s is the tenth largest and the only one not to offer firefighter paramedics.

On May 29, 2007 the Kern County Grand Jury stated that their investigation revealed there was tension between the private ambulance operators in the county and Kern County Fire Department regarding providing emergency medical services. The grand jury recommended that Pine Mountain be provided "24-7 paramedic services" because of its population concentration and its remoteness. The closest hospital is nearly an hour away.

Because Hall Ambulance Service, the holder of the exclusive service contract for this region, is owned by Harvey Hall, the mayor of Bakersfield, citizens concerned about public safety issues have repeatedly asked if there is a political barrier to Bakersfield politicians being able to approve a program which Hall and his employees have vehemently opposed. Others have asked if there is an inherent conflict of interest in county supervisors granting a long-term exclusive contract without bids to such a critical business owned by the mayor.

Meanwhile, Hall ambulance was unable to respond to an emergency in Pine Mountain on January 24 because of icy roads. Three to four hours elapsed between a 9-1-1 call and the arrival of Suellyn L’Dera at a hospital in Bakersfield. Four wheel drive passenger vehicles were able to navigate the same roads that same evening, and a light four wheel drive pick-up truck was used to finally take L’Dera to meet the ambulance crew about nine miles from her home.

A Hall representative told L’Dera’s husband via email that training in snow conditions is not a part of their drivers’ preparation. Snow conditions in the Mountain Communities often extend from October to as late as mid-May.

On April 1 the supervisors are scheduled to vote whether to accept a negative recommendation by Ross Elliott, Kern County’s director of emergency medical services, regarding the need for firefighter paramedics in rural areas. Kern County Fire Chief Dennis Thompson objected at the February 12 board meeting to Elliott’s analysis of the data about the need for advanced life support (ALS) paramedic services in what was supposed to have been a joint report.

Elliott had also declined to include an offer in the report from the Kern County Fire Department. Elliott cited budget issues. KCFD wished to provide free firefighter paramedic services to three rural areas for a year, and said they had the funding from outside sources to do so. The goal was to study the merit of fire-service based life support services in regions such as these where reports of slow response by ambulance contractors are an ongoing concern.

Kern County, it is said, is as large as Belgium, and the private ambulance contractors can be stretched thin.

Second District Supervisor Don Maben said fire engines are also sometimes stretched thin in the remote regions of the county. However, fire stations are far more broadly distributed than ambulance dispatch sites. There are three Kern County fire stations in the Mountain Communiites region. One of those is in Pine Mountain, staffed with three firefighters (although the building itself was condemned two years ago).

Fourth District Supervisor Ray Watson said that "in other counties people are taxed for these services," indicating his support for rural residents to pay special assessments if they are to receive firefighter paramedic services.

In fact, according to the Los Angeles County auditor’s office, every building under Los Angeles County jurisdiction is assessed three cents per square foot on their tax bill for emergency medical services. That assessment includes government buildings, churches and such structures exempt from other taxes. The tax is not specific to "rural areas," clerks at that office said in a telephone interview.

At the February 12 board of supervisors meeting, supervisors voted to ask Elliott to gather additional data about the effectiveness of ALS paramedic interventions in emergency patient care. In an interview, Elliott said that records of those who died while waiting for arrival of ambulance paramedics will not be included in the statistics.

Questions about that and about the merit of using a single year of statistics for a very small sample of calls were also raised by Jan de Leeuw, director of UCLA’s Environmental Statistics Department, which is conducting a long term study of EMS services in Kern and counties that surround it.

In the DVD from the fire based EMS services coalition, Dr. Nagel said the 1966 White Paper, "Accidental Death and Disability: The Neglected Disease of Modern Society" (by the National Academy of Sciences), launched the effort to utilize firefighters as the front line responders to medical emergencies: "They are there, we don’t have to invent them, they are stationed throughout the communities." In June 2006, Nagel added, the Institute of Medicine of the National Academies in Washington D.C. issued a report called "Future of Emergency Care" that supports that choice. The recent study projects "a 21st century model of emergency care" which provides seamless transition between 9-1-1 call to pre-hospital EMS paramedic response for advanced life support intervention to stabilize patients prior to transport to hospital-based emergency and trauma care for adults and children.

As an example, he points out that the time between a cardiac arrest emergency and brain death, for instance, can be as little as eight minutes without intervention.

Derek Johnson, president of the Kern County Fire Fighters Union told supervisors at the February 12 meeting that "survivability quadruples with early intervention," noting that Elliott’s own study showed that paramedic firefighters could be on scene an average of 25 minutes sooner than ambulance paramedics to rural ares such as Pine Mountain.

Elliott has long said he thinks "private ambulance service is the best and most cost effective solution." Hall Ambulance experimented with a weekend ambulance facility in Pine Mountain in 2006-07 and pulled out last year citing lack of profitability due to low call volume. Mayor Hall was also stung by the community’s expression of dislike for his request that they provide a free facility for his ambulance staff and offices (built with the community’s sewer fund) and also tax themselves $125 per parcel per year to pay for his business to maintain service to the area. Supervisor Watson was quoted in the Bakersfield Californian as saying the Pine Mountain residents were "inhospitable."

Meanwhile, state "urban wildland interface" grant money secured a third firefighter in Pine Mountain, which sets in place the staffing prerequisite for one of those firefighters to also be a certified paramedic.

On March 18 Robinson said he was making copies of the 10-minute DVD to distribute throughout the Mountain Communities so the public can better understand what is at risk on if the supervisors vote on April 1 to deny the Kern County Fire Department’s offer of a year-long pilot study. [See the video online at www.MountainEnterprise.com].

Following the trip to speak with Supervisor Rubio, Robinson (an L.A. County firefighter paramedic who lives in Pine Mountain with his wife and two small children) wrote a statement to the Pine Mountain Club Property Owners Association Board of Directors. It was read by Roy Warkentin, with a few minor changes, at the PMCPOA’s March 15 meeting. These are excerpts from Robinson’s original letter:

"It is time to put an end to this back and forth procrastinating once and for all regarding the issue of a paramedic for Pine Mountain Club. The writing is on the wall come April 1: the Board of Supervisors are going to vote down the Fire Department’s proposal for a Fire based Paramedic program unless we do something to stop them.

"It is very unfortunate that the community now has to consider a property assessment tax in order to fund a Paramedic for PMC. Yes, it is wrong that we would have to tax ourselves to get a FF/PM here in PMC, but what other alternatives are left? No matter how much this community complains about how unfair it is that we have to pay the same taxes for the same service that is provided to Metro Bakersfield—and assume that we should be entitled to the same services here in PMC—Hall ambulance, County EMS and the Board of Supervisors disagree.

"Low call volume, cost and our choice to live in a rural setting mean we do not get the same service as the general population in the metropolitan area. Bottom line, it is not going to happen now or any time in the future, especially with the current economic crisis facing not only local government, but the State and Federal government as well.

"Over the past week I have had meetings with Supervisor Rubio, the Fire Department, PMC manager Dan Rainey and conversations with citizens.

"Supervisor Rubio is in favor of us taxing ourselves for a firefighter/paramedic and suggested the CSA-40 tax as a way of doing this. This would be separate from the $700,000 that is currently in the existing CSA-40 fund. A new a firefighter/ paramedic assessment tax fund for Pine Mountain would have to be voted in by the community.

"The Fire Department is willing to place a Paramedic in the Fire Station 24/7, 365 days a year for a cost of $9 to $10 per month, per parcel. This figure could be lower, but not higher, they say. KCFD is drafting a revised proposal to outline the total cost analysis for FF/P program that could be voted on by the citizens of PMC.

"To get this information out to the community, the Fire Fighters Union has committed members of the Fire Department and go door to door explaining the cost and the benefits of having a firefighter/paramedic respond to 911 calls.

"This program does not exclude Hall Ambulance Service. They will still respond to all 9-1- 1 calls and continue ALS support during transport to the hospital. The Fire Department paramedic is available to respond in the event of another emergency while we wait for Hall to send a back-up ambulance.

"Comments from residents of PMC include:

Other communities such as Stallion Springs and Bear Valley are aware ofthis paramedic situation and it is apparent that the 11 other rural areas donot share the passion for a paramedic program as we do here. If they did,where is the representation from those communities at the Board ofSupervisor meetings? We can’t even get the majority of our own communityinvolved! The same people turn out to the town hall meetings and it’s oftenthe same people who attend the Board of Supervisors meetings. So, where isthe support from our own community on this issue?

Filing a lawsuit against the county for discrimination… Who is goingto pay for that and how long [will it be tied up in court]?

"Many realize this is a travesty and we should not have to pay for this service, but how many more people are going to die or suffer while waiting 25-30 minutes or longer for an ALS ambulance to arrive? In the mean time, as time ticks by, someone is having a seizure or they are having an anaphylactic reaction to a bee sting and their airway is closing off or they are suffering a cardiac arrest and no cardiac drugs are available to administer within 10 minutes or less. Who wants to volunteer to be in that position next?

"This community at one time consisted of a majority of senior citizens, many with pre-existing health conditions, but younger families have been moving into the area and the census is starting to balance out young, middle aged and senior citizens. We have a school that has an enrollment of 80 children for heaven sakes.

"As a community, we have to ask ourselves: is our loved one, friend and neighbor worth the $9 or $10 per month to have a firefighter/paramedic 24/7, which would never leave the community without ALS care?

"It costs what, $5 to uncork a bottle of wine at the club house? Dinner for two at the Bistro is roughly $40? A couple gallons of gas is about $8 and going up. Cost of a Paramedic: $9. As in the commercial: "Cost of a human life…Priceless!" There are no second chances.

"How much longer are we going to continue this battle? By voting in a property assessment tax and having a full time paramedic it is a win/win situation for PMC and the Fire Department.

"This mountain community started this movement and I believe it is time we finish what we started by embracing the Fire Department’s proposal and achieving our goal. Otherwise, years from now we will still just be talking about it and lives such as Mr. Bailey’s, that could have been saved, will continue to be lost.

"We urge you make it known to the board of Supervisors before April 1 that we are willing to put it to a community vote for a firefighter/paramedic tax assessment."

This is part of the March 21, 2008 online edition of The Mountain Enterprise.